The safe disposal of medical waste is rapidly growing into a crisis of major proportions as a result of the ever increasing use of throw-away materials, and a greater awareness of long-range consequences of inadequate disposal methods, combined with the lack of suitable dump sites and high tech incinerators or other methods of safe disposal. Every presently practiced disposal method for medical waste is adding increasingly to this country's medical care cost, while it is a provisorium at best and far from safe. Nobody knows the exact quantity of medical waste generated by American hospitals, but estimates range from one-half million to three million tons per year. Although the amount appears to be minuscule compared with all United States waste, the cost is not. In 1988 the equivalent of two bags of medical waste was enough to close dozens of beaches in the states of New Jersey and New York and cause three billion dollars in losses for local businesses.
Many large cities resort to either on-site incineration or periodic collection of safely packaged materials for dumping in special landfills to dispose of medical waste. Only in a few cases are high technology community incinerators available which are outfitted with high stacks, emission scrubbers, liming devices, electronic particle precipitators, monitoring instrumentation and trained personnel to guarantee safe operation and disposal of the toxic ash. High cost and the inability to build new incinerators in or near urban areas due to negative public perception, prevents this latter method from gaining greater acceptance, in spite of its advantages.
On-site incinerators in large hospitals cannot be outfitted with adequate pollution control devices and run by highly trained technicians on a financially feasible basis. As a consequence, many of these units operate at a pollution level 10 to 100 fold in excess of legal limits, and only their small size and lack of alternatives keep them from being shut down. Some cities and towns contract for special landfill disposal sites, which must be outfitted with heavy duty watertight liners to prevent infectious run-off into rivers or ground water. But these sites are rapidly filling up and new ones are harder and harder to develop, with costs increasing rapidly. Some states have legislation pending to prohibit this type of medical disposal from out-of-state origins.
A method less frequently employed is the autoclaving of infectious materials prior to conventional disposal to render the materials sterile and harmless so they can be disposed of with kitchen and household refuse. In general, these autoclaves comprise a large pressure vessel into which the waste is loaded. Steam is used to elevate the temperature inside the sealed autoclave until sterilization is achieved. Heat transfer must be effected through the tightly wrapped packages and plastic bags containing the medical waste, a slow and uneven process. Air trapped inside prevents good heat transfer so that cold spots exist which interfere with perfect sterilization unless the holding time is extended several hours to assure that all microorganisms have been rendered completely sterile. Another difficulty is the inability to control internal pressure, so that many bags or packages explode during the process inside the vessel, making the unloading after a long cool down very messy despite the elimination of the infection hazards. While this material might now be disposed of along with other kitchen and household garbage, many dump site operators refuse acceptance of autoclaved medical waste unless repackaged, ground up or otherwise made unrecognizable as medical waste.
For the periodic collection of medical waste, the Federal Environmental Protection Agency has implemented a closely scrutinized tracking and documentation system (1988 Medical Waste Tracking Act) to prevent misuse and guarantee safe procedures. Where disposal sites are still accessible for medical waste, hospitals must depend on periodic collection by state-approved handlers. Medical waste is typically created around the clock in a hospital, and its storage until it is picked up for disposal creates a serious financial expenditure. Special rooms must be outfitted with refrigeration, filtered air ventilation and other safeguards against fermentation, odors, insect, vermin and rodent infestation. Additionally, heavy duty secondary packaging must be applied such as insulated double wall corrugated boxes with plastic liners, et cetera, to safeguard the waste during transportation.